The use of polytetrafluoroethylene (PTFE) to form tubular vascular prostheses is well known. PTFE is particularly suitable as an implantable prosthesis as it exhibits superior biocompatability. PTFE tubes may be used as vascular grafts in the replacement and repair of blood vessels, as PTFE exhibits low thrombogenicity. In vascular applications, grafts are manufactured from expanded polytetrafluoroethylene (ePTFE), as tubes formed therefrom have a microporous structure which allows natural tissue ingrowth and cell endothelialization once implanted in the vascular system. Such structure contributes to the long term healing and patency of the graft.
Vascular ePTFE grafts are made by a paste extrusion process wherein PTFE including a lubricant is extruded into a tubular shape. This tubular extruded product, known as a green tube, is then expanded, typically in the axial direction, to form an ePTFE tube. Grafts formed of ePTFE have a fibrous state defined by interspaced nodes interconnected by elongate fibrils. The fibrils have a tendency to align themselves along the axis of expansion; that is, along the longitudinal direction of the tube. The spaces between the nodes and fibrils of the ePTFE tube define a microporous structure which enhances tissue ingrowth and cell endothelialization. While such microporous structure is beneficial to the healing characteristics of the graft, the alignment of the fibrils along the axis of the graft has a tendency to produce a graft with anisotropic physical properties, for example reduced burst and radial tensile strength of the graft. Further, such microporous structure also increases the likelihood of a tear propagating along the length of the graft. This is especially significant during implantation, when the surgeon places a suture hole in the graft, and during secondary surgical procedures such as thrombectomy. The hole or slit placed in the graft during such procedures may serve as a failure initiation zone and have a tendency to propagate a tear longitudinally along the graft. Finally, such a highly organized fibril structure produces reduced longitudinal suture retention strength, increasing the likelihood of suture pull out during implantation.
Attempts have been made to increase the radial and suture retention strengths as well as to reduce the likelihood of tear propagation in ePTFE grafts. As an example, various techniques have been developed to change the node and fibril arrangement defining the microporous structure of the graft such that the fibrils are aligned more in a randomized direction with respect to the longitudinal axis of the graft.
Manufacturing techniques, such as rotating the extrusion die components which form the green tube, have been employed in an effort to orient the fibrils in a non-longitudinal direction. In this manner, upon expansion, the resulting vascular graft exhibits more randomness in fibril orientation. Other techniques to enhance radial tensile strength, improve suture retention strength, and reduce the likelihood of tear propagation, employ multi-layer structures in forming vascular grafts. These multi-layer ePTFE structures may include sheets, tubes, or tape wraps of various oriented ePTFE structures which, when combined, form a composite structure wherein a more randomized distribution of fibrils exists. However, these multi-layered structures significantly affect the porosity of the composite graft. The porosity of the graft, defined by the microporous structure, is preselected such that it exhibits the desired combination of characteristics leading to sufficient strength and appropriate porous microstructure to facilitate tissue ingrowth and cell endothelialization. By changing the microporous structure using multi-layered structures, the desired porosity characteristics are also changed. Other multi-layered structures may include PTFE tubes over-wrapped with non-PTFE filaments, intended primarily to increase the compression resistance of the resulting composite. Such structures do not address the aforementioned strength issues of the ePTFE graft, and the use of dissimilar material may adversely impact the long-term structural integrity of the composite, thus affecting its biocompatibility.
It is therefore desirable to provide an ePTFE vascular graft which exhibits a high degree of radial tensile strength, as well as reduced tear propagation tendency while still maintaining a desired porosity. It is further desirable to provide an ePTFE graft which exhibits superior suture retention strength.